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95% of AKU, 65% of BU students migrate: study
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KARACHI, Dec, 2007: Over 95% of Aga
Khan University (AKU) and over 65% of Baqai University (BU) final-year medical
students intend to go abroad for postgraduate training, according to a survey
published recently as 'Reasons for migration among medical students from
Karachi' that appeared in the journal Medical Education. |
The two most
important factors, as pointed out by the students, are poor pay and poor quality
of training. Other factors were the poor work environment and lack of rigor in
teaching of residents. Over half of final-year medical students cited these
issues as major reasons behind their decision to migrate.
Staff shortages
in have intensified over the past two decades as a result of brain drain.
Systems in several Western countries depend heavily on imported healthcare
professionals. The dependence of the US on international medical graduates
(IMGs) is encoded in various policies, most specifically in Medicare's financial
support for a number of residency positions that exceed the total number of
domestic medical school graduates. Canada is adding residency positions to
accommodate IMGs and is streamlining immigration and training requirements to
facilitate their direct entry into practice. Although recipient nations and
immigrating doctors benefit from this migration, Southern countries lose out.
Today, educated overseas healthcare professionals represent more than a
quarter of the medical and nursing workforces of Australia, Canada, the UK and
the US. IMGs constitute 23% to 28% of doctors in the US, the UK, Canada and
Australia, and lower income countries supply 40% to 75% of these IMGs.
Similarly, more than 23% of America's 771,491 doctors received their training
outside the US, the majority (64%) in poorer countries. Often the most motivated
and distinguished doctors are the first to leave. This puts the system of the
host country under pressure. The educational programmes and research of the host
countries suffer because the very people who are likely to assume leadership in
academia are those who migrate.
Data show that India, the Philippines
and Pakistan are the leading sources of IMGs.
There are 8 medical
schools in Karachi. Of these, 6 belong to the private sector and the remaining 2
to the government sector.
The study targeted 2 of the largest private
schools, AKU and BU. AKU has to date conferred 1,370 medical degrees. By
contrast BU's first batch of MBBS students graduated in 1993 and to date 1,779
doctors have qualified. According to an AKU estimate, 70% to 80% of its
graduates are working abroad. Similar BU estimations suggest that around 50% of
its graduates are practising abroad.
Over 93% of respondents at AKU and
65% at BU felt that poor quality PGME was the most important factor motivating
them to seek it abroad. A little over half cited economic prospects after
training as an extremely important reason behind their decision to migrate.
Post-training economic prospects was the third most important factor.
Only 17% of AKU students and 7% of BU students indicated any significant
influence of peer pressure. About 10% felt that religious factors contributed to
their migration. Similarly, less than a quarter claimed that any political
factors, relevant to Pakistan or the country of intended migration, contributed
to their decision. Another area of potential intervention related to the poor
work environment in teaching hospitals in Pakistan. Only 12% of students
mentioned long working hours as the reason behind their decision to migrate.
The major contributing factors for students who wished to stay in
Pakistan were family ties, the desire to serve their nation and the desire to
settle in Pakistan. The vast variety of diseases and the bulk of patients
encountered in medical practice in Pakistan, which translate into hands-on
clinical experience, were cited as contributing to a more satisfying process
than that provided by training in the West.
It is often supposed that a
desire to settle in the developed world is the main motivation of people who
migrate abroad. However, the study revealed that only 10% of respondents wanted
to settle abroad after training.
The salary structure of the PGME
programme in Pakistan is very poorly developed. Several trainee institutions
offer an initial salary equivalent to $110 to $180 per month. Also, there are
more medical graduates than training positions in Pakistan as a result of which
some work without salary. Religious issues have also received particular
attention in the media, generally in terms of harassment and discrimination
based on religious grounds. There have been targeted killings of doctors based
on sectarianism and religious extremism, but it is interesting to note that less
than 10% of medical students felt that any religious factor contributed to their
decision to migrate.
There were significant differences in the mean
scores of 4 factors among students from both universities who intended to
migrate. AKU students ranked quality of training and salary much higher than BU
students. This may reflect the fact that many AKU students are exposed to
foreign medical universities during the summers, when they attend overseas
research and clinical electives. It is also possible that the huge loans
received from the university by more than 60% of AKU students, which must be
repaid after graduation, are another incentive for migration. By contrast, BU
students ranked professional satisfaction and the desire to settle abroad higher
than AKU students.
Poor countries offer medical training that produces
too many doctors with highly technical skills for the number of satisfying jobs
available to them. The total expenditure on healthcare in 2002 was just 3% of
gross domestic product. Daily Times
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| Education News | | Updated: 23 May, 2012 |
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